Type 2 Diabetes in Children and Adolescents. Arlan L. Rosenbloom

alt="" target="_blank" rel="nofollow" href="#fb3_img_img_dbe73254-a9cb-598d-aaae-be877cad55c9.jpg"/> Type 2 diabetes associated with increased BMI

      

Australian Aborigines (14)

      

74 children and adolescents followed for 5 years

      

Increase in prevalence of overweight from 2.7% to 17.6% over the 5 years

      

At end of study (mean age 18.5 years) 8% with impaired glucose tolerance, 2.7% with type 2 diabetes and 22% with elevated cholesterol

      

New Zealand Maoris (15)

      

5% of 1,052 diabetes patients diagnosed before age 30, of which 55% were type 2

      

Micro-albuminuria more common in type 2 diabetes (62%) vs. type 1 diabetes (18%)

      

86% of patients with type 2 diabetes overweight vs. 44% of those with type 1 diabetes

      

Female:male 1.5:1

THE EPIDEMIC OF OBESITY

      United States

      

Obesity, defined in adults as a BMI ≥30 kg/m², doubled in frequency in the adult population in the last decade of the 20th century (16).

      

Obesity prevalence in 2000 was ∼20% of adults (16):

      

18.5% of Caucasians

      

29.3% of African Americans

      

23.4% of Hispanics

      

The National Health and Nutrition Examination Survey (NHANES) III conducted between 1988 and 1994 described a doubling in prevalence of childhood obesity since the 1980s (17).

      

NHANES III update of 1999 (18) found BMI >95% for age and sex, varying with ethnicity, in

      

11–18% of boys 6–11 years old

      

10–17% of girls 6–11 years old

      

11–14% of boys 12–19 years old

      

10–17% of girls 12–19 years old

      

The Bogalusa Heart Study, a 20-year (1973–1994), biracial, community-based study in Louisiana of 11,564 individuals 5–24 years old (19):

      

Mean weight increased 0.2 kg/year, and skinfold thickness increased.

      

The frequency of overweight doubled.

      

Overweight (>85th percentile BMI) increased from 15 to 30%.

      

Obesity (>95th percentile BMI) increased from 5 to 11% in those 5–14 years old and from 5 to 15% in those age 15–17 years old.

      

Increases in the second 10 years of the study were 50% greater than those in the first 10 years.

      

The National Longitudinal Survey of Youth, a prospective cohort study of 8,270 children age 4–12 years (22):

      

There was a significant increase in “overweight” (>95th percentile of BMI for age and sex) and risk of overweight (85th–95th percentile of BMI).

      

Prevalence rates in 1998 (Fig. 1) were

      

BMI >85th percentile: African Americans 38.4%, Hispanics 37.9%, Caucasians 25.8%

      

BMI >95th percentile: African Americans 21.5%, Hispanics 21.8%, Caucasians 12.3%

      International

Table 11. Obesity Trends in Children and Youth Outside of the United States

      

Russia—1992 (20)

      

∼7000 patients age 6–18 years examined

      

6% obese (>95th percentile BMI), 10% overweight (85th–95th percentile) using U.S. BMI reference data

      

China—1993 (20)

      

∼3000 patients age 6–18 years examined

      

3.6% obese, 3.4% overweight (as defined above)

      

United Kingdom—1996 (21)

      

22% overweight, 10% obese at age 6 years

      

31% overweight, 17% obese at age 15 years

      

Europe (21): highest rates of childhood obesity in Eastern Europe (particularly Hungary), and Spain, Italy, and Greece

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